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Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width.

Abstract：

BACKGROUND:There is a controversy regarding the association between QRS width and ventricular arrhythmias (VAs). We hypothesized that predictive value of the QRS width could be improved if QRS width were considered in the context of the sum magnitude of the absolute QRST integral in 3 orthogonal leads sum absolute QRST integral (SAI QRST). We explored correlations between QRS width, SAI QRST, and VA in primary prevention implantable cardioverter-defibrillator (ICD) patients with structural heart disease. METHODS:Baseline orthogonal electrocardiograms were recorded at rest in 355 patients with implanted primary prevention ICDs (mean age, 59.5 ± 12.4 years; 279 male [79%]). Patients were observed prospectively at least 6 months; appropriate ICD therapies because of sustained VA served as end points. The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated. RESULTS:During a mean follow-up of 18 months, 48 patients had sustained VA and received appropriate ICD therapies. There was no difference in baseline QRS width between patients with and those without arrhythmia (114.9 ± 32.8 vs 108.9 ± 24.7 milliseconds; P = .230). SAI QRST was significantly lower in patients with VA at follow-up than in patients without VA (102.6 ± 27.6 vs 112.0 ± 31.9 mV·ms; P = 0.034). Patients with SAI QRST (≤145 mV·ms) had a 3-fold higher risk of ventricular tachycardia (VT)/ventricular fibrillation (VF) (hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.59-6.75; P = .001). In the univariate analysis, QRS width did not predict VT/VF. In the bivariate Cox regression model, every 1 millisecond of incremental QRS widening with a simultaneous 1 mV·ms SAI QRST decrease raised the risk of VT/VF by 2% (HR, 1.02; 95% CI, 1.01-1.03; P = .005). CONCLUSION:QRS widening is associated with ventricular tachyarrhythmia only if accompanied by low SAI QRST.

journal_name

J Electrocardiol

journal_title

Journal of electrocardiology

authors

Tereshchenko LG,Cheng A,Fetics BJ,Marine JE,Spragg DD,Sinha S,Calkins H,Tomaselli GF,Berger RD

doi

10.1016/j.jelectrocard.2010.07.013

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

548-52

issue

eissn

0022-0736

issn

1532-8430

pii

S0022-0736(10)00291-8

journal_volume

pub_type

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Ventricular arrhythmia is predicted by sum absolute QRST integralbut not by QRS width.